Özet:

The formation of renal and perirenal apse is rare in childhood. It occurs most often after abdominal and urinary system surgery, but it can rarely occur in healthy children. Vezikoureteral reflux, obstructive uropathy, renal vein thrombosis, renal calculus or renal trauma can occur. Fact: Seven-year-old male patient, from the outer center where he was treated with fever and left side pain complaints for 16 days, was directed to our clinic for further research due to the failure to provide clinical healing. A month ago, he was undergoing hypospadias and left orchiopexy surgery. The left testis is atrophic. It was followed by a urinary sond for 8 days after the hypospadius surgery. Two days after the urinary sond was removed, he was hospitalized due to fever, vomiting, left side pain. The Western ultrasound in the outer center found findings favored pyelonefritis. The patient, who was treated with multi-antibiotic therapy and deposited for sixteen days, was sent to us despite the appropriate paranteral antibiotic therapy without clinical improvement. In his CV, at the age of 3 there was no pathological characteristics except the partial decrease of the left testicle after bilateral orchiopexy surgery. In his past, his father had a history of nefrolithiasis in his childhood, his cousin had diagnoses of intrauterine hydronephrosis. In the examination, the left side had a costavertebral angle sensitivity (KVAH) and a fever of 38.7°C. Laboratory results found CRP:121 mg/L, ESH:120 mg/h, and leukocyte 21380/mm3. In our hospital’s contrasted western BT, a large number of renal apses were detected at a diameter of 3 cm of the left size (Figure 1). The treatment of Meropenem and Teikoplanin was initiated. Apse drainage was performed by initiative radiology. The drainage material was in the exotic vessel, and a lot of neutrophils were seen in direct care. Positive responses were received in laboratory examinations and clinics. Immunological examinations were planned, it was normal. The result: Fever, side pain, cosovertebral angle sensitivity, the height of the acute phase reacts and the possibility of renal apse, though rare, in cases of passed urine system surgery, should be taken into account. It is necessary to diagnose a well taken history and clinically suspect the presence of renal apse. Despite proper antibiotic therapy, patients who do not receive a clinical response can receive meaningful clinical response with percutaneous drainage.